NPIMap

Organization Active NPI

Skyline Pediatrics Professional Corporation

  • Pediatrics Physician
  • Tucson, AZ
National Provider Identifier
1184948416
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
33544 Issued in AZ
Legal business name
SKYLINE PEDIATRICS PROFESSIONAL CORPORATION
Practice address
4930 N 1St Ave
Tucson, AZ 85718-5615
Phone
(520) 577-3333
Fax
(520) 577-4685
NPI assigned
Mar 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brice Kopas, M.D.NPI 1942282140
Title
President
Phone
(520) 834-5020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 33544 AZ Primary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 40475 AZ

Addresses

Primary practice location

4930 N 1St Ave
Tucson, AZ 85718-5615

Mailing address

4930 N 1St Ave
Tucson, AZ 85718-5615
Phone (520) 577-3333

Other identifiers 2

IdentifierTypeStateIssuer
932617MedicaidAZ
355175MedicaidAZ

Other names 1

  • Skyline Pediatrics PC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1047783Skyline Pediatrics, PC4930 N First Ave, Tucson, AZ 85718Certificate of waiverNov 13, 2027

National Provider Directory

National Provider Directory

Locations

4930 N 1st Ave
Tucson, AZ 85718
Phone (520) 440-0341

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1184948416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 N 1ST AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857185615",
            "telephone_number": "520-577-3333",
            "fax_number": "520-577-4685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 N 1ST AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857185615",
            "telephone_number": "520-577-3333",
            "fax_number": "520-577-4685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE PEDIATRICS PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "KOPAS",
        "authorized_official_first_name": "BRICE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-834-5020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "33544",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "40475",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "932617",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355175",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skyline Pediatrics PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.